“If history is our guide, we can assume that the battle between the intellect and will of the human species and the extraordinary adaptability of microbes will be never-ending.” (1)
Despite all the remarkable technological breakthroughs that we have made over the past few decades, the threat from infectious diseases has significantly accelerated. In this course, we will learn why this is the case by looking at the fundamental scientific principles underlying epidemics and the public health actions behind their prevention and control in the 21st century.
This course covers the following four topics:
1. Origins of novel pathogens;
2. Analysis of the spread of infectious diseases;
3. Medical and public health countermeasures to prevent and control epidemics;
4. Panel discussions involving leading public health experts with deep frontline experiences to share their views on risk communication, crisis management, ethics and public trust in the context of infectious disease control.
In addition to the original introductory sessions on epidemics, we revamped the course by adding:
- new panel discussions with world-leading experts; and
- supplementary modules on next generation informatics for combating epidemics.
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(1) Fauci AS, Touchette NA, Folkers GK. Emerging Infectious Diseases: a 10-Year Perspective from the National Institute of Allergy and Infectious Diseases. Emerg Infect Dis 2005 Apr; 11(4):519-25.
What you'll learn
- Demonstrate knowledge of the origins, spread and control of infectious disease epidemics
- Demonstrate understanding of the importance of effective communication about epidemics
- Demonstrate understanding of key contemporary issues relating to epidemics from a global perspective

Taught By

Gabriel M. Leung (HKU)

Joseph T. Wu (HKU)

Kwok-Yung Yuen (HKU)

Tommy Lam (HKU)

Maria Huachen Zhu (HKU)

Guan Yi (HKU)

Chair Professor

Benjamin Cowling (HKU)

Professor

Thomas Abraham (HKU)

Associate Professor

Mark Jit (LSHTM)

Professor

Malik Peiris (HKU)

Chair Professor

Marc Lipsitch (Harvard)

Professor

Transcript

In this session, our learning objective is to understand the importance and methods of conducting post-marketing surveillance of a vaccine. Even after a vaccine receives a marketing license, surveillance is still necessary to detect adverse events that occur following vaccination but are too rare to be seen in pre-licensure trials, or that only occur some time after vaccination. Post-marketing studies are also used to investigate long-term vaccine efficacy. These studies are called phase IV studies. A higher standard of safety is expected for vaccines compared to therapeutic drugs because they are administered to healthy individuals in order to prevent potential disease rather than to sick patients. Furthermore, if a vaccine programme is successful, the incidence of the disease will fall. As a result, public fear of the disease may diminish as memories of its consequences recede. People may be tempted to rely on herd protection from other people who have been vaccinated, rather than to get vaccinated or to have their children vaccinated. Being able to reassure people of the safety of a vaccine is vital to ensuring that vaccine uptake does not decrease when this happens. For example, uptake of MMR or measles-mumps-rubella vaccination dropped sharply in the United Kingdom following the suggestions of a link with bowel disease and autism in 1988. Even though the link was subsequently discredited, coverage took many years to recover. An adverse event is an untoward medical occurrence in someone administered a vaccine, whether or not it was actually caused by the vaccine. Passive surveillance relies on health care providers reporting adverse events that they observe. Any reports of serious adverse events are investigated in order to determine whether or not they were actually caused by the vaccine. Adverse events may be unrelated to vaccination, because when a large number of vaccination events occur, some adverse events may simply be by chance. Another form of surveillance is the use of large linked databases that enable the vaccination status of individuals to be systematically linked to any health outcomes that may occur. These can detect very rare adverse events that were not observed during clinical trials. The rate of adverse events in vaccinated and unvaccinated people can be compared to statistically investigate whether the adverse events occurred simply by chance. If a causal relationship between vaccination and an adverse reaction is supported by evidence, then the risks and the benefits of the vaccine need to be assessed in order to determine whether vaccination should continue. For example, rotavirus vaccination was found in post-marketing surveillance to be associated with a very small increased risk of intussusception, a serious condition involving the intestines. The risk was too small to be detected in phase III clinical trials. The WHO and national advisory committees have concluded that the benefits of rotavirus vaccination still greatly outweigh the risks. This is because the risk of severe rotavirus leading to hospitalisation or death in unvaccinated children is hundreds of times greater than the increased risk of intussusception in vaccinated children.

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